PREOPERATIVE PATIENT CONTACTS AND POSTOPERATIVE WEIGHT LOSS AFTER BARIATRIC SURGERY: A RETROSPECTIVE STUDY

Abstract

Background: Obesity is a significant threat to the health of millions of Americans. The disease is strongly associated with a number of conditions that increase the risk of premature mortality, including type 2 diabetes, hypertension, obstructive sleep apnea, and certain cancers. Bariatric surgery, specifically Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG), produce significant and durable weight losses. Third-party payers require that patients complete a number of preoperative consultations, typically including a medical assessment and mental health evaluation, as well as medical weight management (MWM), which typically consists of 3-6 months of in-person visits with a primary care provider or registered dietitian (RD). The number of visits and duration of the preoperative consultation and MWM process is often dictated by the patient’s third-party payer. Few studies have investigated if these contacts are associated with greater postoperative weight loss. Further, the relationship of these preoperative contacts to postoperative follow-up, which is associated with weight maintenance, is unknown. Objective: To determine if the frequency of preoperative contacts, and the duration of the preoperative assessment period (and duration of MWM in particular), is associated with percent weight loss in the first two years following bariatric surgery. The relationship between preoperative contacts with postoperative attrition also was explored. Methods: One thousand five hundred bariatric surgery cases from 2009-2014 from a single institution were analyzed. Preoperative contacts were abstracted from the electronic medical record and categorized by type. Weight was collected from postoperative visits with the surgical practice or primary care physician records. Generalized linear mixed models were used to assess the relationship between the frequency of preoperative contacts and duration of preoperative care with the bariatric surgery team and weight loss in the first 24 months after surgery. Logistic regression models were used to assess the association between the number of preoperative contacts and the duration of the preoperative assessment period with completion of postoperative follow up visits. Results: The frequency of preoperative contacts (including individual visits, education sessions, support groups, psychology visits, telephone calls, and electronic messages) and duration of preoperative care were not associated with postoperative percent weight loss. A greater number of individual visits with the bariatric surgery team was associated with 0.26% smaller postoperative weight loss (95% CI -0.47%, -0.05%; P = 0.02). Additional contacts with the psychologist also were associated with 1.46% smaller postoperative percent weight loss (95% CI -2.79%, -0.12%; P = 0.03). Number of preoperative contacts and duration of preoperative care were not associated with postoperative follow up. Conclusion: The frequency of preoperative contacts with the bariatric surgery team, and the duration of preoperative care, were not associated with weight loss in the first two years after bariatric surgery. More individual visits with the bariatric team and additional visits with the psychologist prior to surgery were associated with smaller postoperative weight loss. These results suggest that the intensity and length of the preoperative assessment period, which is often mandated by third party payers, is unrelated to early postoperative weight loss. More extensive preoperative assessment by the multidisciplinary team, and mental health professional, however, may be identifying patients who are at risk for smaller postoperative weight losses. Further research should attempt to determine an appropriate recommendation for MWM in respect to duration and frequency, while also considering the quality and content of these clinical visits.